The document discusses tumors of the pineal gland. It begins by describing the location and structure of the pineal gland. Pineal region tumors constitute a small percentage of intracranial tumors but are clinically important due to their location. Symptoms include increased intracranial pressure, headaches, nausea, and visual problems. The document then discusses the different types of pineal tumors and how they appear on various imaging modalities like MRI, CT, and radiography. Common tumors mentioned are germinomas, pineoblastomas, pineocytomas, and pineal cysts. MRI is the preferred imaging method for delineating pineal masses and distinguishing true pineal tumors from parapineal masses.

1. Pineal Gland
Tumors

2. Introduction
 Pineal Gland is midline structure located in the
epithalamus, near the centre of the brain, between the
two hemispheres, in a groove where the two halves of
the thalamus join.
 Pineal region neoplasm's constitute only 0.3-2.7% of
intracranial tumors.
 They are considered an important clinical entity because
of their strategic location.

5. Clinical features
• hydrocephalus and increased intracranial pressure
• headaches
• nausea
• vomiting
• lethargy
• altered mental function.
• Visual Problems
• Parinaud's syndrome, which includes inability to look
upward, double vision and nystagmus

6. Differential diagnosis of pineal
region mass
• Pineal parenchymal tumours
• Pineocytoma
• Pineal parenchymal tumour with intermediate differentiation
• Papillary tumour of the pineal region
• Pineoblastoma
• Germ cell tumours
• Pineal germinoma (most common; ~ 50% of all tumours)
• Pineal embryonal carcinoma
• Pineal choriocarcinoma
• Pineal yolk sac carcinoma - endodermal sinus tumour
• Pineal teratoma

7. • astrocytoma of pineal gland
• pineal metastasis
• pineal cyst
• meningioma near pineal region
• cavernoma in pineal region
• aneurysm in pineal region

8. Pineal calcification: seen in approximately 40% of normal people by the
age of 20 years and usually less than 1 cm in diameter. Larger calcifications
should raise concerns for underlying tumor.

9. MRI
•MRI is the preferred imaging modality
•enables the accurate delineation of pineal masses before
surgery.
•allows true pineal masses to be distinguished from
parapineal masses that impinge on the pineal gland

10. Limitations
• Computed tomography (CT) scanning may be needed to
evaluate a calcified pineal gland that is associated with a
pineal germinoma or tumor calcification associated with
other neoplasms in the pineal region.

11. Radiography
• Germinomas are associated with a high incidence of
pineal gland calcification.
• The tumor does not calcify, but it may engulf a calcified
pineal gland.
• A calcified pineal gland on plain radiographs in a boy
younger than 10 years suggests pineal germinoma.

12. Computed Tomography
• Nonenhanced CT scans
• Typically demonstrate a slightly hyperattenuating
mass that engulfs a prominent calcified pineal gland.
• Contrast-enhanced CT scanning
• demonstrates homogeneous and intense
enhancement.

13. • More sensitive than plain radiography in depicting pineal
calcification.
• Small speckles of calcification can be seen in children 6
years and are considered normal
• Pineal calcification in children younger than 6 years is
suggestive of pineal neoplasm.
• Pineal calcifications should be less than 1 cm in diameter
in size.

14. Germinoma …..MRI findings
•T1/T2:
• Usually isointense relative to cerebral gray matter
•Occasionally
• T1:hypointense
• T2:hyperintense
• I/V injection of gadolinium-based contrast material,
• homogeneous and intense enhancement is seen.
• contrast-enhanced MRI (subarachnoid seeding of
germinomas.)

15. Pineal germinoma in a 30-year-old man. Axial T2-weighted
MRI shows a mildly hyperintense lesion involving the pineal
region.

16. Pineal germinoma in a 30-year-old man. Sagittal T1-
weighted contrast-enhanced image demonstrates an
enhancing mass in the pineal region.

17. Pineal germinoma in a 30-year-old man. Sagittal T1-
weighted contrast-enhanced image demonstrates an
enhancing mass in the pineal region.

18. Pineal germinoma in a 30-year-old man. After radiation
therapy, sagittal T1-weighted contrast-enhanced MRI
demonstrates no abnormal enhancing tumor.

19. Pineal germinoma in a 19-year-old man. Axial T1-weighted MRI shows an
isointense lesion in the pineal region.

20. Pineal germinoma in a 19-year-old man. Axial T2-
weighted MRI shows an isointense mass in the pineal
region.

21. Pineal germinoma in a 30-year-old man. Sagittal T1-weighted contrast-enhanced
image demonstrates an enhancing mass in the pineal region.

22. Pineal germinoma in a 19-year-old man. Sagittal T1-weighted
contrast-enhanced MRI image demonstrates an enhancing
mass in the pineal region. Compression of the aqueduct is
shown.

23. Axial, post-contrast CT demonstrates an enhancing mass in the
pineal region, which engulfs a calcified pineal gland

24. Pineoblastoma
CT IMAGING
•The solid component tends to be slightly hyperdense
compared to adjacent brain due to high cellularity.
• Peripherally disperse or "exploded" calcification
(Mnemonic: blasted calcification), similar to pineocytomas.
In contrast pineal germinomas tend to engulf pineal
calcification.

25. MRI IMAGING
•T1 - isointense to hypointense to adjacent brain
•T2 isointense to adjacent brain
•Areas of cyst formation or necrosis my be present
•T1 C+ (Gd) - vivid heterogeneous enhancement

26. T1 weighted post contrast axial views showing an enhancing mass in pineal region
and areas of necrosis within it after treatment

27. Axial T1 weighted MRI with contrast showing pineoblastoma

28. Papillary tumor of the pineal
region (PTPR)
•T1 hyperintense
•The presence of such a mass in the posterior commissure
or pineal region, in the imaging absence of fat,
hemorrhage, melanin, or calcification, suggests the
diagnosis of PTPR.

29. Pineal cysts
• Benign cysts in the pineal gland, which have been found
in almost a quarter of healthy young adults,
• Are sharply delineated and ovoid shaped, with signal
intensity similar to ventricular CSF on both T1- and T2-
weighted images.
• Diameter (range, 2–14 mm).
• Incidental finding , rarely become symptomatic.

30. A T2-weighted axial MR scan shows an ovoid mass
in the pineal region with smooth edges and
isointense to CSF.

32. T1 sagittal and axial views :Ruptured dermoid

33. Pineocytoma on precontrast Sagittal T1-weighted MR shows an
ovoid lesion that is hypointense to white matter and close to
CSF in signal intensity

34. Pineocytoma on Axial T2-weighted MR image shows a
homogeneous ovoid lesion (arrow), which is isointense to
CSF in signal intensity with a thin intermediate-intensity rim
centered on the pineal region.

35. Pineocytoma on postcontrast Axial postcontrast T1-weighted MR
image shows a homogeneously enhancing mass (arrow) centered
on the pineal recess

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